title: Urinary incontinence after stress incontinence surgery: a risk factor for depression.
abstract: OBJECTIVE
  To determine whether urinary incontinence after stress incontinence surgery is a risk factor for concomitant symptoms of depression.
  
  
  METHODS
  Women who underwent stress urinary incontinence surgery from 1993 to 2002 were given 2 validated quality-of-life questionnaires, the Incontinence Symptom Index and the Patient Health Questionnaire, to assess the severity of urinary incontinence symptoms after surgery and to identify moderate-to-severe depressive symptoms, respectively. Bivariate and multivariate statistical models were then constructed to determine the independent parameters associated with the reporting of moderate-to-severe depressive symptoms in this group of women.
  
  
  RESULTS
  Of the 687 identified women, 437 (64%) returned completed questionnaires. The average patient age was 59 years, with a median follow-up after the index surgery of 2.9 years (range 0.4-10.1). Urinary incontinence after stress incontinence surgery was found to be an independent risk factor for associated moderate-to-severe depressive symptoms. Each 10-point increase in the Incontinence Symptom Index total symptom severity score resulted in a near doubling of the odds of having concomitant depressive symptoms (odds ratio 1.93, 95% confidence interval 1.41-2.65). Additional comorbid conditions (odds ratio 1.46, 95% confidence interval 1.23-1.73), additional postoperative vaginal prolapse surgery (odds ratio 3.20, 95% confidence interval 1.30-7.89), and perimenopausal status (odds ratio 3.79, 95% confidence interval 1.60-8.95) were also significantly associated with depressive symptoms.
  
  
  CONCLUSIONS
  Urinary incontinence after stress incontinence surgery is strongly associated with moderate-to-severe postoperative depression symptoms, even years after the index surgery. Additional studies are necessary to examine the causal relationships between incontinence and depression.
authors.affiliation: Department of Urology, Lahey Clinic, Burlington, Massachusetts, USA.
authors.forename: John T
authors.initials: JT
authors.lastname: Stoffel
authors.forename: Daniel
authors.initials: D
authors.lastname: Morgan
authors.forename: Rodney
authors.initials: R
authors.lastname: Dunn
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Hsu
authors.forename: Dee
authors.initials: D
authors.lastname: Fenner
authors.forename: John
authors.initials: J
authors.lastname: Delancey
authors.forename: Edward J
authors.initials: EJ
authors.lastname: McGuire
authors.forename: John T
authors.initials: JT
authors.lastname: Wei
mesh_terms: D003430:Cross-Sectional Studies; D003863:Depression / Q000209:etiology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D017211:Treatment Failure; D014549:Urinary Incontinence / Q000150:complications*; D014550:Urinary Incontinence, Stress / Q000601:surgery*